enlargement of the male breast. The definition has nothing to do with what causes the enlargement or what tissue it is composed of. It is most common around puberty & can be unilateral or bilateral. Most commonly the enlargement is centralized in the breast but occasionally it is not.
The classes & causes are
..Newborn-caused by placental hormones & resolves within a few weeks
..Adolescence-caused by alterations in estrogen:testosterone ratio &
usually resolves after puberty (usually within 1 to 2 years)
..Aging (involutional)-caused by testicular failure & treated by testosterone
..Obesity-caused by the conversion of androgens to estrogen in peripheral
fat & treated first by diet/exercise/weight loss
..Deficient production or action of testosterone
..After testicular trauma
..Increased estrogen production
..Tumors within the breast or other organs
..Liver, adrenal or thyroid disease
..A wide variety of prescribed medicines
4. Familial-inborn error of metabolism
The majority of cases are physiological or drug induced. Evaluation by a qualified physician is required to see which category you fall into. The treatment of the physiological category is straightforward while the pathological is more complicated. Drug induced gynecomastia just requires cessation of the causative drug. If the gynecomastia is resistant to treatment or is the adolescent type but persistent surgery is required. Gynecomastia arising before the onset of puberty requires a vigorous diagnostic workup because of the possibility of life threatening or shortening pathology.
The type of surgery depends on the type of tissue contributing to the breast enlargement
..glandular: requires surgical removal of glandular tissue
..fatty-glandular: requires surgical removal of glandular tissue with or without removal of adjacent fat to give the best overall shape
..simple fatty: requires diet/exercise for weight loss, possibly removal of the fat
Fat removal can be accomplished by direct excision with or without liposuction. It can be very difficult to discern how much of the excess tissue is fat vs. gland on external physical exam, even by very experienced people. Also if the breasts are very large & ptotic excess skin will also have to be removed in order to achieve the best aesthetic result. The only exception to this is when surgery is performed before the onset of puberty in which case continued growth will catch up the excess skin. Almost no cases of gynecomastia are adequately treated with liposuction alone. Also the glandular portion of gynecomastia is unaffected by diet or exercise.